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This is the first in a series of articles to be published serially in the Psychiatric Bulletin on recent government policy and legislation. Each article will describe a different piece of legislation and place it in its international perspective, highlighting how it will affect individual psychiatric practice, users of mental health services and the working relationship with purchasers and managers. The articles are aimed at all practising psychiatrists and those in training who wish to familiarise themselves with the important recent legislation that is having a profound effect on the practice of psychiatry in the UK. The legislation that will be covered includes the NHS and Community Care Act, The Health of the Nation community care plans and mental illness specific grant, the care programme approach, discharge and aftercare planning procedures, NHS trusts, fundholding and commissioning general practitioners and the purchaser provider split. There will be a summarising article to reflect common themes and trends. The series was commissioned by Dr Sara Davies and Dr Jeanette Smith, Trainee Editors at the Psychiatric Bulletin.

The National Health Service and Community Care Act, 1990, enacts some provisions contained in the Working for Patients and Caring for People White Papers. The former measures were introduced immediately in 1990 and contain, for example, the legal basis for NHS trusts and fund-holding GPs. Most of the community care sections of the Act were delayed in their implementation until April 1993. The key element is allocating the main coordinating responsibility as ‘lead agency’ to local social service authorities; they are charged with conducting ‘needs assessments’ on clients presenting with problems. Whether, however, there is a legal obligation upon social services departments to provide care for people with unmet needs to not yet dear.

A representative sample of 307 consultant psychiatrists was canvassed regarding experiences and views of continuing medical education (CME). Full responses were received from 73%. The results indicated that most respondents already participated in a range of CME activities, inducing attendance at local and other educational meetings, and teaching. Those respondents who had few consultant peers, or who did not teach psychiatric trainees or medical students, also participated in fewer CME activities. Nearly half the sample funded their CME activities wholly or in part from their own pockets. The majority of respondents supported some form of specialist accediation based on participation in CME.

This article outlines a problem in the referral pattern for mental health workers on the Isle of Wight, when they require psychiatric or psychological help. The authors are concerned that treatments are offered by colleagues. A survey undertaken of 12 community mental health units in Wessex seems to indicate that there are no dear policies or financial arrangements for referrals to other units. The authors agree that the treatment of mental health workers everywhere may be compromised in the market economy, if trusts start to function, because of economic pressures, as islands.

The Merck Essay Prize was inaugurated in 1993. All trainee psychiatrists (senior house officers, registrars or senior registrars) in the United Kingdom and Republic of Ireland were eligible to submit an essay on the topic: ‘Depression: Counting the Costs’. The winning essay by Dr Peter Haddad is printed here. The runners-up in Joint second place were Dr J. Bray, Lecturer, University of Leicester (Leicester General Hospital) and Dr R. Bullock, Senior Registrar, St Mary Abbots Hospital, London.

Depressive illness is the commonest form of mental disorder in the community. Its effects are far-reaching and include psychological suffering and social disruption for affected individuals and their families, increased mortality, and direct and indirect financial costs for society. Only about half of all cases of depression are recognised by doctors and not all of these receive effective treatment. The costs of depression could be reduced if detection and treatment were improved. Addressing this is a major challenge for psychiatric services.

People with the dual diagnosis of mental illness and mental retardation have proved difficult to resettle from hospital. Yet there is considerable evidence that, if diagnosed correctly, treatment for such patients can be effective (e.g. Matson, 1981; Welch ft Sigman, 1980). This paper describes the outcome of treatment at a specialist unit for patients with dual diagnosis.

I previously reported (O'Shea, 1989, 1992) on the experience of national voluntary Huntington's disease (HD) and Alzheimer's disease (AD) organisations. This series of enquiries stemmed from an observation of Black (1988) that the medical profession in general offered little support to voluntary groups, a statement which has been largely supported for both HD and AD organisations in the first two parts of this trilogy. This final paper examines the experiences and attitudes of (mostly national) schizophrenia organisations.

The limited previous research on usage of section 136 of the Mental Health Act 1983 (MHA) has either confined itself to description of socio-demographic and clinical data (Dunn ft Fahy, 1990) or considered procedural issues solely in urban areas (Rogers ft Faulkner, 1987). This is despite the repeated concern of the Mental Health Act Commission (1991), which has noted more widespread difficulties in the use of section 136, highlighting individual failures by local services to adhere to the Code of Practice MHA (Department of Health and Welsh Office, 1990). This study attempts a region-wide survey of section 136 agreements and the corresponding frequency of use of the procedures. This is in line with the Reed Committee recommendations (Department of Health/Home Office, 1992), which prioritised early diversion from custody as an area of research, and emphasised the desirability of multi-agency section 136 agreements.

Multi-agency review of the diversion of mentally disordered offenders in the Southampton area did not reveal particular problems or lack of professional interest, but delays and difficulties could occur at any stage. To enhance the diversion process a facilitator approach was established. An experienced social worker undertook the roles of acting as a link, educator, supervisor and monitor. This has encouraged discontinuance of criminal proceedings, assisted the integration of mentality disordered offenders into ordinary psychiatric services and reduced the need for specialist assessment and care.

Beckside Computer Workshop is a small rehabilitation project based in the south of the city of Lincoln. The project aims to provide young people who have a history of schizophrenia with an opportunity to acquire basic keyboard and computing skills and at the same time to improve their ability to operate confidently in new social situations. Some are recruited from a health service funded rehabilitation hostel but most participants are living in the community. Ultimately, it is hoped that some of those taking part will eventually gain meaningful employment.